[Usefulness of combination post-stress dysfunction and perfusion imaging in technetium-99m-tetrofosmin myocardial scintigraphy].

OBJECTIVES: Myocardial perfusion imaging has lower sensitivity for the diagnosis of coronary artery disease in patients with three-vessel disease. The presence of post-stress dysfunction of the left ventricle, evaluated by electrocardiography(ECG) gated single photon emission computed tomography(SPECT) with a quantitative gated SPECT program, was investigated in patients with coronary artery disease, and also whether combining post-stress dysfunction and myocardial perfusion imaging improved the diagnosis of coronary artery disease. METHODS: ECG gated technetium-99m-tetrofosmin SPECT was performed using a one day, stress and rest, protocol in 139 patients. SPECT and coronary angiography were performed within 1 month. The coronary artery disease group consisted of 89 patients: 43 with one-vessel disease(1VD), 28 with two-vessel disease(2VD), and 18 with three-vessel disease(3VD). The group with zero-vessel disease(0VD) consisted of 50 patients. According to post-stress and rest ejection fraction(EF) and end-systolic volume (ESV), post-stress dysfunction is defined as follows: rest EF--post-stress EF > or = 5% and post-stress ESV--rest ESV > or = 5 ml. RESULTS: In the coronary artery disease group, post-stress ESV was larger than rest ESV(37.8 +/- 26.4, 34.0 +/- 24.2 ml, p < 0.001), and post-stress EF was lower than rest EF (61.5 +/- 11.1%, 64.2 +/- 10.8%, p < 0.001). In the 0VD group, ESV and EF were the same for post-stress and rest (25.7 +/- 20.8, 26.2 +/- 21.6 ml, NS; 70.4 +/- 9.5%, 70.0 +/- 9.6%, NS). Post-stress dysfunction was 6.0% in the 0VD group and 30.3% in the coronary artery disease group(p < 0.001). Furthermore, post-stress dysfunction in the 2VD (35.7%) and 3VD(38.9%) groups was higher than that in the 0VD group(p < 0.01, p < 0.01). Sensitivity of coronary artery disease diagnosis by myocardial perfusion imaging was 75%. The combination of post-stress dysfunction and myocardial perfusion imaging improved sensitivity from 75% to 82%(p < 0.05), but reduced the specificity from 92% to 86%(p = 0.08). CONCLUSIONS: Post-stress dysfunction is a useful parameter for clinical diagnosis of coronary artery disease.

Ultraviolet irradiation of titanium dioxide in aqueous dispersion generates singlet oxygen.

We previously reported that irradiation of titanium dioxide (TiO2) in ethanol generates both singlet oxygen (1O2) and superoxide anion (O2*-) as measured by EPR spectroscopy. The present study describes the production of reactive oxygen species upon irradiation of TiO2 in aqueous suspension as determined by EPR spectroscopy using 2,2,6,6-tetramethyl-4-piperidone (4-oxo-TMP) and 5,5-dimethyl-pyrroline-N-oxide (DMPO). Photoproduction of 1O2 by suspended TiO2, detected as 2,2,6,6-tetramethyl-4-piperidone-N-oxyl (4-oxo-TEMPO), was measured in water and deuterium oxide (D2O) in the presence or absence of sodium azide (NaN3) and under air or argon atmospheres. Production of a DMPO-OH adduct was examined in 4-oxo-TMP containing medium in the presence or absence of dimethyl sulfoxide (DMSO). The signal for the DMPO spin adduct of superoxide anion was not observed in aqueous conditions. Kinetic analysis revealed that 1O2 was produced at the surface of irradiated TiO2 in aqueous suspension as was observed in ethanol. Kinetic analysis revealed that the formation of DMPO-OH adduct reflects oxidation of DMPO by 1O2 rather than the trapping of the hydroxyl radical produced by the reaction of photo-exited TiO2 and water. The production of large amounts of 1O2 by TiO2 in aqueous suspension as compared to those in ethanol and possible formation of hydroxyl radical in aqueous suspension but not in alcohol, suggest that irradiation of TiO2 in aqueous environments is biologically more important than that in non-aqueous media.

[Transient left ventricular dysfunction is still present one hour after exercise stress test: evaluation by gated SPECT with 99mTc-labeled perfusion agent].

It has been reported that quantitative gated SPECT (QGS) has revealed post-stress dysfunction of the left ventricle (LV) 30 minutes after a stress test. The purpose of this study was to determine whether post-stress dysfunction of LV is still present one hour after an exercise stress test. The subjects comprised 152 patients (124 males and 28 females, mean age 59 +/- 10 years). Exercise stress myocardial scintigraphy was performed using a one-day, stress and rest protocol. 99mTc labeled myocardial perfusion tracer, tetrofosmin, 370 MBq was injected at the end-point of a supine ergometer stress test for stress imaging. ECG gated SPECT was carried out 1 hour after injection. Three hours later, 740 MBq to 1100 MBq of 99mTc labeled myocardial perfusion tracer was injected for rest imaging. ECG gated SPECT was again performed 1 hour after injection. We divided the subjects into four groups according to the severity score of defects on the stress image and the presence or absence of fill-in; normal (NOR, n = 59), myocardial infarct (MI, n = 65), small ischemia (S-IS, n = 13) and large ischemia (L-IS, n = 15). Post-stress dysfunction is defined according to two criteria: 1) rest LVEF--post-stress LVEF > or = 5% and 2) post-stress ESV--rest ESV > or = 5 ml. The frequency of post-stress dysfunction was 3.4%, 9.1%, 23.1% and 40% in NOR, MI, S-IS and L-IS, respectively. Post-stress LV dysfunction was found to be more frequent in the large ischemia group. In conclusion, post-stress dysfunction was present 1 hour after the stress test and was more frequent in the large ischemia group.

Irradiation of titanium dioxide generates both singlet oxygen and superoxide anion.

Although photoexcited TiO2 has been known to initiate various chemical reactions, such as the generation of reactive oxygen species, precise mechanism and chemical nature of the generated species remain to be elucidated. The present work demonstrates the generation of singlet oxygen by irradiated TiO2 in ethanol as measured by ESR spectroscopy using 2,2,6,6-tetramethyl-4-piperidone (4-oxo-TMP) as a 1O2-sensitive trapping agent. Under identical conditions, the superoxide ion was also detected by spin trapping agent 5,5-dimethyl-pyrroline-N-oxide (DMPO). Kinetic analysis in the presence of both 4-oxo-TMP and DMPO revealed that singlet oxygen is produced directly at the irradiated TiO2 surface but not by a successive reaction involving superoxide anion. The basis for this view is the fact that DMPO added in the mixture increased the signals responsible for 4-oxo-2,2,6,6-tetramethyl-1-piperidinyloxy (4-oxo-TEMPO), a reaction product of 4-oxo-TMP and 1O2. The detailed mechanism for the generation of 1O2 and superoxide ion by irradiated TiO2 and reactions between these species and DMPO are discussed.

Analysis of reactive oxygen species generated by neutrophils using a chemiluminescence probe L-012.

Reactive oxygen species (ROS) play important roles in the defense mechanism against infection and in the pathogenesis of various diseases. Although chemical properties of ROS generated by leukocytes have been studied extensively, methods available for their analysis are not sufficiently sensitive. We found that 8-amino-5-chloro-7-phenylpyrido[3,4-d]pyridazine-1,4-(2H,3H)dione (L-012) reacted with various types of ROS generated by activated neutrophils in human blood and oral cavity, and from peritoneal cavity of the rat, and developed strong chemiluminescence (CHL). Under physiological conditions, opsonized zymosan-dependent CHL intensity of L-012 in human blood and rat peritoneal neutrophils was about 100 and 10 times higher than that of luminol and luciferin analog MCLA, respectively. Phorbol ester-activated CHL of oral neutrophils was also higher with L-012 than that with luminol and MCLA. The presence of either superoxide dismutase, catalase, uric acid, deferoxamine, or azide decreased CHL intensity of L-012 by 52, 57, 57, 63, and 91%, respectively. Kinetic analysis revealed that L-012 developed CHL predominantly by reacting with hydroxyl radical and hypochlorite. Thus, highly sensitive L-012 permits studies on ROS generation by complex biological systems, such as leukocytes, and on the role of ROS in the pathogenesis of various diseases.

In vivo analysis of hydrogen peroxide and lipid radicals in the striatum of rats under long-term administration of a neuroleptic.

It has been hypothesized that free radicals play a causative role in tardive dyskinesia, which is an inveterate movement disorder caused by chronic administration of neuroleptics. To verify this hypothesis, rats were reared while being regularly treated with water containing a neuroleptic, haloperidol (HPD), for 1 year (HPD group). The changes in the striatal hydrogen peroxide content of the rats in the HPD and control groups were measured by using a Pt-disk microelectrode while the animals were in a freely moving state following intraperitoneal administration of HPD (HPD challenge). We also performed electron spin resonance (ESR) detection of lipid radicals in the striatum before the HPD challenge. HPD challenge led to significant elevation of the intrastriatal hydrogen peroxide in all animals, but the elevation in the HPD group was smaller than that in the control group. However, in the HPD group, marked ESR signals of intrastriatal lipid radicals were observed. We think that these results support the hypothesis on the role of free radicals in tardive dyskinesia.

Synthesis of spin labels for ESR imaging of living rat head.

Spin labels (7, 10, 13, 16, 22, 27) were synthesized from piperidinyloxyl (1), pyrrolidinyloxyl (2), and oxazolidinyloxyl (3). These compounds were injected into the carotid artery of anesthetized rats, and the ESR spectra of the rat brain were immediately recorded by the use of an L-band ESR spectrometer. Based on the spectra obtained, we considered whether or not these spin labels can pass the blood brain barrier and bind to brain tissue components.

Generation of lipid radicals in the hippocampal extracellular space during kainic acid-induced seizures in rats.

We report direct electron spin resonance (ESR) evidence of extracellular free radical formation during kainic acid-induced seizures obtained using in vivo brain microdialysis in freely moving rats. Saline solution containing the spin trap agent alpha-(4-pyridyl-N-oxide)-N-tert-butylnitrone was perfused through the hippocampus. ESR analysis of the dialysate samples revealed a six-line spectra, for which the hyperfine coupling constants corresponded to those of the ESR signal from the lipoxygenase/linoleic acid system, a lipid radical generating system. This result is direct evidence that lipid peroxidation of the neuronal membrane progresses during seizure activity. Increased formation of lipid radicals may participate in the cascade of reactions leading to neuronal damage in the hippocampus following kainic acid-induced seizure activity.

Synthesis and evaluation of DMPO-type spin traps.

The spin traps substituted with some groups at the 4-position of dimethyl-1-pyrroline N-oxide(DMPO) were compared with DMPO itself regarding their abilities as spin traps and their physical properties. 4,5,5-Trimethyl-1-pyrolline N-oxide (4MDMPO) and 5,5-dimethyl-4-phenyl-1-pyrolline N-oxide (4PDMPO) were synthesized by the Bonnett method, and 5,5-dimethyl-4-hydroxymethyl-1-pyrolline N-oxide (4HMDMPO) was made by a unique method from 2(5H)-furanone. The melting points of 4MDMPO, 4PDMPO and 4HMDMPO were higher than that of DMPO. The magnitude of hydrophilicity was in the order of 4HMDMPO, DMPO, 4MDMPO, and 4PDMPO based on the partition coefficient experiments in a 1-octanol--water system. Several radicals, O2-., HO., .CH3, .CH2OH, .CH(CH3)OH, (CH3)3CO. and H. radicals, were trapped with these DMPO derivatives for comparison with the trapping by DMPO itself. Spin adducts of O2-. with the three DMPO derivatives showed ESR spectra similar to that of DMPO. In spite of the formation of diastereomers arising from spin trapping, the line-width enlargement was very small. The intensities and the decay rates of the spectra of 4MDMPO-O2-, 4PDMPO-O2-, 4HMDMPO-O2- and DMPO-O2- were almost equal. In the trapping of the .OH radical by 4MDMPO, 4PDMPO and 4HMDMPO, the eight-line ESR spectra observed were different from the well-known four-line spectrum of DMPO-OH.

Quantification of urinary porphyrins by liquid chromatography after oxidation of porphyrinogens.

A quantitative "high-performance" liquid-chromatographic method is described for determining porphyrins in human urine. Porphyrinogens in urine are first converted to the corresponding porphyrins by oxidation with iodine. Uroporphyrin, hepatacarboxylic acid porphyrin, hexacarboxylic acid porphyrin, pentacarboxylic acid porphyrin, and coproporphyrin I and III isomers are then separated on a reversed-phase column and measured by fluorometry. Analysis for the six porphyrins is complete within 24 min, including reconditioning for the next sample. The detection limit (twice the signal/noise ratio) for each porphyrin was 1 nmol/L for urine (25 fmol per 50-microL injection). Mean analytical recovery of each porphyrin ranged from 85% to 91%, within-day CVs from 1.4% to 7.3%. Normal reference intervals for porphyrins were established by assaying urine samples from 75 healthy subjects. Significant sex-related differences in coproporphyrin I and III isomers were evident when the values were expressed as nanomoles per gram of creatinine. Coproporphyrin isomer ratio was estimated for utility in the diagnosis of porphyrinurias.

Specific determination of 3-methoxy-4-hydroxyphenylethylene glycol in urine by liquid chromatography with post-column reaction.

We describe a "high-performance" liquid-chromatographic method for determining 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) in human urine. MHPG is separated on a reversed-phase column with isocratic elution, oxidized with sodium metaperiodate, and its absorbance measured at 365 nm. This method shows higher specificity, less interference for MHPG than methods involving electrochemical or fluorescence detection. Post-column derivatization of MHPG with periodate yields vanillin. The detection limit (twice the signal-to-noise ratio) in urine samples was 0.08 mg/L. Mean analytical recovery was 72%. Within-assay and day-to-day CVs were 2.9% and 6.5%, respectively. Reference intervals for MHPG in 24-h urine from apparently healthy subjects were 0.85-3.24 mg/day for men and 0.63-2.20 mg/day for women. In terms of creatinine excretion, the respective reference intervals were 0.55-1.99 and 0.70-1.96 mg per gram of creatinine.

High-performance liquid chromatographic analysis of a new beta-lactam antibiotic, 6059-S (moxalactam).

Reversed-phase high-performance liquid chromatography was applied to the quantitative determination of a new beta-lactam antibiotic, 6059-S, ant its R- and S-epimers were resolved. The procedure was also applied to pharmaceuticals and human urine samples. Chromatographic separation was effected on a bonded hydrophobic stationary phase with two mobile phases: methanol-phosphate butter for the resolution of the epimers and methanol-tetra-n-butylammonium phosphate for the quantitation of 6059-S. For the determination of 6059-S in human urine, the latter mobile phase was used successfully without interference by the other urine components. An in vivo experiment was conducted by administering intravenously 1 g of 6059-S to seven volunteers and analysing their urine by chromatographic and microbiological assays, and a comparison of the results gave a correlation coefficient of 0.9954. One-compartment model analysis of the time-course data revealed that 6059-S was excreted in urine intact with a rate constant of 0.433h-1.

Metabolism and disposition of peptido-aminobenzophenone (2-o-chlorobenzoyl-4-chloro-N-methyl-N-glycylglycinanilide) and its major benzodiazepine metabolites in dogs.

Absorption, metabolism, and excretion of peptido-aminobenzophenone (PAB) and its major benzodiazepine-type metabolites were studied in dogs. In one dog, PAB levels reached a peak, which was low relative to that of other metabolites, at 1 hr after a single 5-mg/kg oral dose and decreased with a half-life of 1.2 hr. PAB in plasma was metabolized rapidly and extensively into chlorodiazepam (CD) and further into chlorodesmethyldiazepam (CDD). The two first-pass effects of both PAB and CD were observed. Urine following a 20-mg/kg oral dose of PAB contained the lorazepam conjugate (16.4%) as a major metabolite and a trace amount (0.2%) of PAB. The inverse relationship between CD plasma clearance and iv CD dose is probably explained by product inhibition of CD demethylation by CDD. Study of the in vitro metabolism of CD with dog liver microsomes supported the above mechanism.

Separation of some polypeptide hormones by high-performance liquid chromatography.

Twenty-one analogues of ACTH, three analogues of LH-RH and four insulins have been successfully separated on a commercial reversed-phase material with tartrate buffer--acetonitrile systems containing sodium 1-butanesulphonate and sodium sulphate as the mobile phase. The effect of the constituent amino acid residues on the order of elution has been studied in detail by using a variety of closely related peptides; the order of elution of a series of peptides, which differ by only one amino acid residue, can in most instances be explained in terms of the difference in the hydrophobicities of the amino acid residues concerned, but in some instances, such as in diastereoisomers or positional isomers, the order of elution must be interpreted in terms of the hydrophobicity of the whole peptide molecule. This chromatographic method has been proved to be very useful for the rapid examination of the purity of these peptide hormones and for the separation of closely related peptides with molecular weights up to ca. 6000.